Waist-hip ratio and low HDL predict the risk of coronary artery disease in Pakistanis

Nishtar, Sania; Wierzbicki, Anthony S.; Lumb, P J; Lambert-Hammill, Michelle; Turner, C; Crook, Martin; Mattu, Mohammad A; Shahab, Saqib; Badar, Asma; Ehsan, Aayesha; Marber, Michael; Gill, Jaswinder

doi:10.1185/030079903125002595

Cited by 46 publications

(49 citation statements)

References 37 publications

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“…A large body of evidence has established total and LDL cholesterol as important cardiovascular risk factors, in particular among patients with diabetes (2,6,34). However, in parallel to the results of our prospective study, no significant associations between high total or LDL cholesterol and the presence of CAD have been found in cross-sectional angiographic investigations (27,28,35). Among our coronary patients, 31.3% were on statins.…”

Section: Lipid Risk Factors In Diabetes and Ifgsupporting

confidence: 61%

Is Atherosclerosis in Diabetes and Impaired Fasting Glucose Driven by Elevated LDL Cholesterol or by Decreased HDL Cholesterol?

et al. 2005

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OBJECTIVE -To evaluate the atherogenicity of lipids in coronary patients with normal fasting glucose (NFG), impaired fasting glucose (IFG), and type 2 diabetes. RESEARCH DESIGN AND METHODS -Serum lipid values, the presence of angiographic coronary artery disease (CAD) at baseline, and the incidence of vascular events over 2.3 years were recorded in 750 consecutive patients undergoing coronary angiography.RESULTS -Triglycerides significantly (P Ͻ 0.001) increased and HDL cholesterol (P Ͻ 0.001) as well as LDL particle diameter (P Ͻ 0.001) significantly decreased from subjects with NFG Ͻ5.6 mmol/l (n ϭ 272) over patients with IFG Ն5.6 mmol/l (n ϭ 314) to patients with type 2 diabetes (n ϭ 164). Factor analysis revealed two factors in the lipid profiles of our patients: triglycerides, HDL cholesterol, apolipoprotein A1, and LDL particle diameter loaded high on an HDL-related factor, and total cholesterol, LDL cholesterol, and apolipoprotein B loaded high on an LDL-related factor. In patients with type 2 diabetes, the HDL-related factor (odds ratio 0.648 [95% CI 0.464 -0.904]; P ϭ 0.011), but not the LDL-related factor (0.921 [0.677-1.251]; P ϭ 0.597), was associated with significant coronary stenoses Ն50%. Consistently, in the prospective study, the HDL-related factor (0.708 [0.506 -0.990]; P ϭ 0.044), but not the LDL-related factor (1.362 [0.985-1.883]; P ϭ 0.061), proved significantly predictive for vascular events in patients with type 2 diabetes. CONCLUSIONS -The low HDL cholesterol/high triglyceride pattern is associated with the degree of hyperglycemia. In coronary patients with type 2 diabetes, this pattern correlates with the prevalence of CAD and significantly predicts the incidence of vascular events. Diabetes Care 28:108 -114, 2005E pidemiologic data from the Framingham Study (1) and the Multiple Risk Factor Intervention Trial (2) indicate that the risk for cardiovascular death is increased two-to threefold in type 2 diabetic individuals. Moreover, after a first myocardial infarction, cardiovascular morbidity and mortality are increased in patients with diabetes compared with nondiabetic patients (3). In the U.K. Prospective Diabetes Study, protocols targeted to optimize glycemic (4) or blood pressure control (5) failed to significantly reduce the incidence of myocardial infarction. Therefore, and because in the U.K. Prospective Diabetes Study plasma levels of LDL cholesterol and low levels of HDL cholesterol were strong predictors of myocardial infarction (6), the main interest for risk intervention now focuses on lipids. However, it is still not clear which lipoprotein abnormality predominantly endangers diabetic patients.Typically, patients with type 2 diabetes are characterized by hypertriglyceridemia and low HDL cholesterol levels (7), whereas levels of LDL cholesterol have been reported to be normal (7), higher (8) or lower (9) than those in nondiabetic control subjects. Moreover, compositional changes of lipoproteins have been demonstrated: both LDL and HDL are smaller and denser than average (10)...

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Section: Lipid Risk Factors In Diabetes and Ifgsupporting

confidence: 61%

Is Atherosclerosis in Diabetes and Impaired Fasting Glucose Driven by Elevated LDL Cholesterol or by Decreased HDL Cholesterol?

et al. 2005

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“…First, the study is estimating the impact of various modifiable risk factors for MI that should be of considerable relevance to the prevention and control of cardiovascular disease in Pakistan, including, as noted above, tobacco consumption, dietary intake, and physical activity [5,6,22,23]. The second focus of PROMIS is to contribute to scientific (particularly genetic) discovery in an ethnicspecific context.…”

Section: Discussionmentioning

confidence: 99%

The Pakistan Risk of Myocardial Infarction Study: a resource for the study of genetic, lifestyle and other determinants of myocardial infarction in South Asia

et al. 2009

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The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched controls aged 30-80 years. For each participant, information has been recorded on demographic factors, lifestyle, medical and family history, anthropometry, and a 12-lead

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“…Atherosclerotic disease correlates with low HDL, waist-hip ratio, markers of inflammation and insulin resistance [15] and reduced glomerular filtration rate [16] in this Pakistani cohort of Indian Asians. A previous work in the field of M-IRS has suggested that the previous World Health Organisation definition (Table 1) [17] was a better predictor of risk of diabetes and cardiovascular disease compared to NCEP in Caucasians and also that the IDF definition predicted cardiovascular risk better in Caucasian women [18].…”

Section: Discussionmentioning

confidence: 98%

“…The study cohort consisted of 400 patients recruited with ethical consent who underwent coronary angiography from 1998 to 2001 for presenting symptoms of chest pain [8]. Two groups were selected based on the presence of significant CAD as defined by a 50% stenosis in one or more coronary arteries and an age-and sex-matched control group presenting with similar symptoms but with no angiographic evidence of disease.…”

Section: Methodsmentioning

confidence: 99%

Waist circumference, metabolic syndrome and coronary artery disease in a Pakistani cohort

Wierzbicki

Nishtar

Lumb

et al. 2008

International Journal of Cardiology

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Waist-hip ratio and low HDL predict the risk of coronary artery disease in Pakistanis

Abstract: The cardiovascular risk profile in this population is consistent with metabolic syndrome where low HDL and WHR can be used to predict the risk of CAD. Results suggest the need to redefine the currently practised approach to CAD management in this population to fit local needs.

Cited by 46 publications

References 37 publications

Is Atherosclerosis in Diabetes and Impaired Fasting Glucose Driven by Elevated LDL Cholesterol or by Decreased HDL Cholesterol?

Is Atherosclerosis in Diabetes and Impaired Fasting Glucose Driven by Elevated LDL Cholesterol or by Decreased HDL Cholesterol?

The Pakistan Risk of Myocardial Infarction Study: a resource for the study of genetic, lifestyle and other determinants of myocardial infarction in South Asia

Waist circumference, metabolic syndrome and coronary artery disease in a Pakistani cohort

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